Objective: This study aims to investigate the correlation between visually assessable imaging markers and their clinical symptoms in Multiple System Atrophy (MSA) patients.

Background: MSA is a complex neurodegenerative disease characterized by autonomic dysfunction, parkinsonism, and cerebellar ataxia. It is categorized into neuropathologically established MSA, clinically established MSA, clinically probable MSA, and possible prodromal MSA. The latest diagnostic criteria emphasize the importance of neuroimaging markers from brain magnetic resonance imaging (MRI) alongside clinical symptomatology assessment.

Method: This study enrolled 89 MSA patients from the Department of Neurology at the Second Affiliated Hospital of Zhejiang University, including 67 MSA-P and 22 MSA-C patients. Comprehensive clinical assessments were conducted, including demographics, autonomic dysfunction, and neurological function scores. All participants underwent 3.0T MRI scanning to evaluate various imaging features, such as the “hot cross bun” sign, putaminal iron deposition, and cerebellar atrophy. PET imaging and statistical analyses, including t-tests, Mann-Whitney tests, and Canonical Correlation Analysis (CCA), were also performed to explore the associations between imaging markers and clinical features.

Results: CCA indicated a strong intercorrelation between putamen iron deposition grade, midbrain to pons ratio, and hot cross bun grade with clinical symptoms. The hot cross bun grade and midbrain to pons ratio were correlated with cerebellar dysfunction, while putamen iron deposition grade was associated with parkinsonism, especially in the MSA-P subtype. 18F-FDG PET/CT imaging results supported these findings.

Conclusion: Visually assessable imaging markers are crucial in diagnosing and assessing MSA. The study’s findings suggest that putamen iron deposition grade, midbrain to pons ratio, and hot cross bun grade are significant indicators of disease severity in MSA patients, providing valuable insights into the disease’s manifestation and progression.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/correlation-of-lmaging-markers-with-clinical-features-in-multiple-system-atrophy-patients/